After informed consent was obtained the patient was brought to the operating room and placed in the supine position. The correct patient and procedure were identified and a Time Out was performed. After induction of general anesthesia, patient was intubated transnasally from right nostril. The table was turned to 90 degree and head was extended. 2% xylocaine with 1:100,00 epinephrine was injected over the left side of the maxillary gingivolabial sulcus.
Patient was prepped and draped in usual fashion.
Approximately 3 cm long incision was made along the mucogingival junction on the left side preserving the gingiva at the dental margin. This went from just to the right of the central incisor and over to the left molar. Supraperiosteal dissection was performed till the desired vestibular depth using predominantly a 15 blade. The periosteum was intentionally incised towards the height of the sulcus to promote attachment of the mucosa and maintain a deep sulcus with healing.
In the process of obtaining adequate release towards the intended sulcus depth, a connection to the nasal cavity was noted where the fistula was previously repaired. Tissue manipulation was done around the left nasal fistulous tract to allow for closure and it was then sutured with 5-0 vicryl in intermittent fashion.
Leak test performed showed no leak. Another suture in figure 8 fashion was then also applied over the closure to ensure no leak.
The free cut mucosal edge of the lip tissue was then sutured to the depth of the vestibular sulcus using interrupted 4-0 monocryl sutures. The remaining raw periosteal surface was covered with a 2×2 cm piece of Neox 1K membrane and was secured with intermittent sutures with 4-0 monocryl. Hemostasis was great throughout requiring very little cautery..
A periopak was created that was also mixed with doxycycline powder and applied over the surgical site. Mouth was closed to reshape the Coepack dressing to remove excess material and to prevent chipping off while eating.
Having tolerated the procedure well the patient was turned back over to anesthesia, awakened and transferred to the recovery room in stable condition.
This video demonstrates the bilateral suprazygomatic maxillary nerve (SZMN) block performed using both landmark-based and ultrasound-guided techniques for intraoperative and postoperative analgesia in a 12-month-old child undergoing cleft palate repair. The maxillary nerve, located within the pterygopalatine fossa, is the second division of the trigeminal nerve (V2) and is a purely sensory nerve that supplies sensation to the midface, including the palate.
We present in this video our innovative approach to mild to moderately sized perforations in the setting of chronic eustachian tube dysfunction with push through myringoplasty using tragal cartilage graft with primary T-tube. There was improvement in conductive hearing loss while allowing for stable middle ear ventilation with this technique.
This video demonstrates a myringoplasty procedure using Neox RT – a human birth tissue allograft – to repair a tympanic membrane perforation in a pediatric patient. Neox RT is indicated as a wound covering for dermal ulcers or defects, but it holds further utility for myringoplasty. Birth tissue contains growth factors that stimulate epithelialization, as well as extracellular proteins that furnish scaffolding material for wound repair. These properties make it a natural and appealing option to induce tympanic membrane regeneration and healing.
We employ a “sandwich” technique, in which pieces of the allograft are placed both medial and lateral to the perforation. Simple overlay and underlay techniques have been tried with success, but the allograft is packaged as a single piece that affords enough material to craft two smaller pieces. The simultaneous placement of medial and lateral grafts not only avoids waste but may increase success.
Both pieces are trimmed to be slightly larger than the perforation. After freshening the edges of the perforation with a Rosen pick and partially filling the middle ear with dry, absorbable gelatin sponge, trimmed pieces of allograft are inserted sequentially in underlay and overlay fashion to remain medial and lateral to the perforation. Both the underlay and overlay pieces cover the perforation and overlap the native tympanic membrane around the perforation. More absorbable sponge is then inserted lateral to the graft to hold it in place against the tympanic membrane. Finally, antibiotic drops and bacitracin ointment are placed in the canal.
Double-chambered right ventricle repair for an adolescent male who presented with a subaortic perimembranous ventricular septal defect, a subaortic membrane with associated left ventricular outflow tract obstruction, and a double-chambered right ventricle. This video highlights a VSD patch closure and the surgical resection of the subaortic membrane and RVOT muscle bundles.
This video provides an overview of Ebstein’s Anomaly, detailing its classification and the indications for surgical intervention. It features a case study an Ebstein Abnomaly Annuloplasty repair for an adolescent female who has an apically displaced tricuspid valve with severe regurgitation and a central coaptation defect. It also offers an overview of the patient’s post-operative course.
This video demonstrates how to perform an ultrasound-guided iPACK (infiltration between the popliteal artery and the knee capsule) block as an adjuvant technique for postoperative pain control in a pediatric patient presenting for anterior cruciate ligament repair.
Surgical correction with a one-patch interatrial baffle for a patient with a persistent left superior vena cava and a secundum atrial septal defect.
Mitral valve annuloplasty repair for an adolescent female that has mitral valve regurgitation, an A2/A3 prolapse, and a dilated left atrium and ventricle.
This video demonstrates how to perform an ultrasound-guided single-shot adductor canal block for postoperative pain control in a pediatric patient presenting for anterior cruciate ligament repair.
